Arterial Graft Choice and Outcomes Within the Veterans Administration, a 20 Year Review of 47,525 Patients.

There is increasing interest in expanding the use of multi-arterial grafting in coronary artery bypass grafting (CABG) due to improved long-term patency rates and outcomes. These outcomes have not been reviewed extensively in Veterans. Using the Veterans Affairs (VA) Corporate Data Warehouse (CDW), Veterans who underwent CABG surgery using cardiopulmonary bypass within the (VA) hospital system from October 1st, 2003 through September 30th, 2023 were analyzed. Propensity matching compared survival in patients undergoing single versus multi-arterial grafting. 47,525 Veterans were identified. 1084 patients underwent IMA +RA, 2549 underwent BIMA, and 43,892 underwent single IMA grafting. Propensity matching yielded 3286 pairs. In these matched patients, there was no difference in 30-day mortality: 1.31% MAG versus 1.34% SAG (p = 1.00). By 5 years, this diverged with a statistically significant lower mortality noted with MAG (14.1%) compared to SAG (16.3%) (p =.018). This trend continued at 10 years (27.1% vs 32.2%, p<.001) and 15 years (36.7% vs 41.7%, p <.001), all favoring MAG. Rates of 30-day myocardial infarction remained slightly higher with SAG (3.68%) versus MAG (2.98%) (p = .130). There was no difference in 30 day PCI (0.70% MAG vs 0.70% SAG, p = 1.00) or cerebrovascular events (1.67% MAG vs 2.07% SAG, p = .275). Multi-arterial grafting is feasible and safe within the Veteran population. Compared to single arterial grafts, multi-arterial grafting in Veterans is associated with improved mortality beginning at 5 years postoperatively.